Policy & Political Action

Urge CNO Council to allow RNs to continue to initiate the controlled act of psychotherapy independently

Submitted by pgbatten on Thu, 2017-12-21 16:42

The Ontario government will proclaim psychotherapy as a controlled act on Dec. 31, 2017. To address RNAO’s concerns regarding RNs not being able to independently initiate psychotherapy once this change occurs, the government has put in place a two-year transition period until Dec. 31, 2019, to allow psychotherapy providers to register with one of the six colleges authorized to perform psychotherapy. While this is a good first step, it will not solve the issue over the long term unless the College of Nurses of Ontario (CNO) uses this time to change its requirement that RNs must obtain an order from a prescriber to independently initiate treatment. Minister of Health Eric Hoskins wrote to CNO’s president Dalton Berger on Dec. 21, 2017 requesting that CNO allow RNs to initiate the controlled act independently in order to maintain access to high quality mental health services in Ontario. Now it is up to CNO to act.

RNAO has strongly advocated to ensure RNs who have the appropriate education and training can continue to independently initiate the controlled act of psychotherapy. However, the College of Nurses of Ontario (CNO) decided to bar RNs from initiating this treatment without an order from a prescriber (NP or physician) after it is proclaimed a controlled act.

This decision was made despite recommendations from HPRAC in 2006 that each of the colleges should outline appropriate guidelines and standards for their members and avoid dual memberships, and despite the fact that RNs who are mental health nurses often have even more extensive education and experience initiating and delivering psychotherapy than some members of the other five colleges. The College of Psychologists of Ontario, College of Physicians and Surgeons of Ontario, Ontario College of Social Workers and Social Service Workers, College of Occupational Therapists of Ontario, and the College of Registered Psychotherapists have already outlined appropriate guidelines and standards for their members to initiate this controlled act, and thus avoid dual memberships.

Unlike these colleges, CNO has decided to require its members – who have been practising psychotherapy for years and some for decades – to obtain an order from a prescriber to continue treatment. As a result, our members have been so frustrated and demoralized about their knowledge and skills not being recognized that some are seeking recognition from other colleges to maintain their autonomy. Others have decided to suspend their private practice.

Those who practise psychotherapy regularly treat the most vulnerable populations who have serious mental health issues. Denying RNs who have the knowledge and training to practise psychotherapy the ability to initiate the controlled act will hinder access to vital mental health services for Ontario’s most marginalized populations.

For the sake of our patients, there needs to be equity amongst the professionals authorized to initiate and perform psychotherapy. Once psychotherapy becomes a controlled act, all those who meet set standards to practise psychotherapy must be able to do so independently.